Scientific Article   |    
Partial Posteromedial Olecranon Resection: A Kinematic Study
S. Kamineni, MD; H. Hirahara, MD; S. Pomianowski, MD; P. G. Neale, MS; S. W. O'Driscoll, PhD, MD; N. ElAttrache, MD; K.-N. An, PhD; B. F. Morrey, MD
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Investigation performed in the Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, Minnesota

S. Kamineni, MD
H. Hirahara, MD
S. Pomianowski, MD
P.G. Neale, MS
S.W. O'Driscoll, PhD, MD
K.-N. An, PhD
B.F. Morrey, MD
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street
Southwest, Rochester, MN 55905.

N.S. ElAttrache, MD
Kerlan-Jobe Sports Medicine Clinic, 6801 Park Terrace Drive, Los Angeles, CA 90045

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Kerlan-Jobe Orthopaedic Foundation and Mayo Foundation. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

J Bone Joint Surg Am, 2003 Jun 01;85(6):1005-1011
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Background: The posteromedial aspect of the olecranon process is a site of impingement and subsequent osteophyte development in throwing athletes. Treatment with débridement, with resection of osteophytes and varying amounts of normal olecranon bone, is common. We found no reports in the literature concerning the effects of resecting different amounts of normal bone from the posteromedial aspect of the olecranon. We hypothesized that excessive resection would increasingly alter elbow kinematics and that an optimum amount of olecranon resection could be identified.

Methods: We investigated the kinematic effects of increasing valgus and varus torques and posteromedial olecranon resections, in twelve cadaveric elbows, with use of an electromagnetic tracking device. Two valgus and two varus torques were applied, and three sequential resections were performed in 3-mm steps from 0 mm to 9 mm. Statistical analyses included paired t tests, 95% confidence intervals, a one-factor analysis of variance with repeated measures, and a post hoc test when significance was established.

Results: Sequential partial resection of the posteromedial aspect of the olecranon resulted in stepwise increases in valgus angulation with valgus torque. Clear differences were seen at each level of resection. A pattern of increased valgus angulation also was seen in association with increased valgus torque. Increased valgus torque resulted in a trend toward increased axial internal rotation of the ulna, whereas increased osseous resection resulted in a decrease in the absolute degree of internal rotation or, in some specimens, increased external rotation.

Conclusions: Although no single critical amount of olecranon resection was identified, valgus angulation of the elbow increased in association with all resections, with a marked increase occurring in association with a 9-mm resection. Our findings challenge the rationale of removing any amount of normal olecranon bone in throwing athletes as doing so may increase strain on the medial collateral ligament. The implications for the professional throwing athlete are important, and we recommend that bone removal from the olecranon be limited to osteophytes, without the removal of normal bone.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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